Claims Adjudicator (Mentor):
Adjudicates or processes health and/or dental benefit claims for payment. Reviews and adjudicates complex or specialty claims independently and, in a senior capacity, provides training to lower level Claims Adjudicators. Acts as Team Leader, as needed. Typically requires at least four years of claims processing experience. Determines whether to return, suspend, deny, or pay claims within established policies and procedures. Compares claim application and/or provider statement with plan file and other records to evaluate completeness and validity of claim. Analyzes and answers inquiries regarding claim adjudication, including method of payment, co-pay or deductible amounts, and or reason for denial. Adjusts claims that have been denied, overpaid, or underpaid. Routes claims requiring additional information or high-level decision-making. Researches claims and appeals as needed. Requests information from internal or outside sources to ascertain completeness and validity of claim including coordination of benefits information. Analyzes claims to determine extent of liability and settles claims with claimants in accordance with policy provisions. Corresponds with agents and claimants to correct errors or omissions on claim forms and to investigate questionable entries. [-] Less

Cost of Living Data

A renter's cost of living for someone making $44,425 in Woodland, Washington is 96.3% of the US National Average. For more information, or to compare cost of living data between two cities, click here.